Explanation of 21 Day Rule

Explanation of the need for Medical Prescription for physical therapy.

There are two aspects to consider 1) Legal need for prescription and 2) Insurance requirement.

Legally physical therapy can be provided without a prescription for 21 days.

The State of Florida license medical practitioners allowing them to practice their profession in this state.

The Law that governs the licensure of physical therapists is Florida Statute 486 (FS486).

21 Day Rule

FS486 states that “If physical therapy treatment for a patient is required beyond 21 days for a condition not previously assessed by a practitioner of record, the physical therapist shall obtain a practitioner of record who will review and sign the plan. A health care practitioner licensed under chapter 458, chapter 459, chapter 460, chapter 461, or chapter 466 and engaged in active practice is eligible to serve as a practitioner of record.”

Essentially this indicates that physical therapy can be provided for 21 days from the initial evaluation if treatment is not concluded a physician licensed in Florida must sign that physical therapy treatment plan as indicated.

In addition: The State of Florida cannot regulate or verify if a physician from another state has a license in good standing.

Insurance Payment:

Many insurance companies require a physician prescription or referral to establish medical necessity before they will provide payment for physical therapy. If a patient chooses to engage a physical therapist for service and it has not been previously found by a physician to be medically necessary the patient may be responsible for payment for that treatment. Likewise, some insurance require a physician sign the plan of care as medically necessary, that is outlined by the physical therapist in the evaluation to certify treatment. If the physician does not sign the plan of care the insurance may not pay for treatment.

We at Professional Physical Therapy and Associates make every effort to verify the insurance benefits of each patient. However, many insurance companies include a clause in their verification that the terms in the patient’s policy dictates the insurance benefits and that information provided by that department is not a guarantee of payment and that eligibility is determined at the time the claim is received. Furthermore, the plan of care is sent to the physician when the physical therapist completes the initial evaluation and our staff will call the physician if we do not get the plan of care returned within 2 weeks.

If we have not gotten the physician’s signature within 30 days we may ask the patient to contact their physician to expedite and insure the insurance requirement is met.